LD in Hemifacial Spasm

Hemifacial Spasm From Lyme Disease: Antibiotic Treatment Points to the Cause

LeWitt TM.

Clinical Neuropharmacology, online first, 2016 Oct 14.



A wide range of etiologies can cause hemifacial spasm (HFS), including infection. In this case report, a 44-year-old woman developed HFS and was explored surgically 7 years later. No abnormalities were found.

Afterward, treatment of a surgical wound infection with an oral cephalosporin resulted in a temporary HFS remission that had never occurred previously. This antibiotic experience prompted further workup for an underlying infection, which ultimately led to diagnosis of Lyme disease.

Presentation of HFS due to Lyme disease has not been reported. Because its diagnosis can be occult and antibiotic therapy can be both diagnostic and therapeutic, Lyme disease should be a consideration for cases of HFS.

http://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/cranial-nerve-disorders/hemifacial-spasm  Hemifacial spasm is painless involuntary twitching of one side of the face due to malfunction of the 7th cranial nerve (facial nerve). This nerve moves the facial muscles, stimulates the salivary and tear glands, enables the front two thirds of the tongue to detect tastes, and controls a muscle involved in hearing.  The diagnosis is made when doctors see the spasms.

Treatment:  Botulinum toxin, sometimes surgery

Botulinum toxin is the drug of choice. It is injected into the affected muscles. The same drugs used to treat trigeminal neuralgia—carbamazepine, gabapentin, phenytoin, baclofen, and tricyclic antidepressants (see Table: Drugs Used to Treat Depression)—may be tried but are usually not helpful.  If drug treatment is unsuccessful, surgery may be done to separate the abnormal artery from the nerve by placing a small sponge between them.

This case is another great example of doctors stumbling upon a diagnosis of LD due to positive results after antibiotic therapy.  Also, due to an “official” reporting, hopefully doctors will consider LD in their differential diagnosis with other patients presenting with hemifacial spasming.  I can’t help but wonder how many doctors would not even consider LD because there had been no “official” reporting in the past.